基于氧合指数指导下的进阶式肺康复训练结合俯卧位通气对重度老年ARDS患者心肺功能及血气指标的影响

目的探究基于氧合指数指导下的进阶式肺康复训练结合俯卧位通气对重度老年急性呼吸窘迫综合征（ARDS）患者心肺功能及血气指标的影响。方法选取128例重度老年ARDS患者,采用随机数字表法将患者分为对照组和观察组,每组64例,对照组给予俯卧位机械通气和肢体被动活动,观察组增加基于氧合指数指导下的进阶式肺康复训练,对比2组患者的心功能右心室舒张末面积/左心室舒张末面积（RV/LV）、下腔静脉内径及血清肌酸激酶同工酶（KM-MB）和心肌肌钙蛋白T（cTnT）水平]、肺功能第1秒用力呼气容积（FEV1）、第1秒用力呼气容积占用力肺活量百分比（FEV1/FVC）]、血气指标氧合指数（PaO2/FiO2）、血氧饱和度（SaO2）、动脉血氧分压（PaO2）及动脉血二氧化碳分压（PaCO2）]和并发症发生情况。结果治疗后观察组FEV1、FEV1/FVC、PaO2/FiO2、SaO2和PaO2水平明显高于对照组,PaCO2、KM-MB、cTnT、RV/LV和下腔静脉内径水平及并发症发生率低于对照组（P<0.001或P<0.01或P<0.05）。结论基于氧合指数指导下的进阶式肺康复训练结合俯卧位通气可有效治疗重度老年ARDS患者,有效改善患者肺功能状态和血气指标,有效缓解患者的临床症状,同时减轻机械通气对心功能的损伤,减少并发症的发生,具有较高的安全性。

Influence of Oxygenation Index-Guided Advanced Pulmonary Rehabilitation Training Combined with Prone Position Ventilation on Cardiopulmonary Function and Blood Gas Indexes in Elderly Patients with Severe ARDS

Objective To explore the effect of oxygenation index-guided advanced pulmonary rehabilitation training combined with prone position ventilation on cardiopulmonary function and blood gas indexes in elderly patients with severe acute respiratory distress syndrome(ARDS).Methods A total of 128 elderly patients with severe ARDS were randomly given prone position ventilation and passive limb movement(control group,64 patients)or in combination with passive limb movement(observation group,64 patients).Heart function(right ventricular end-diastolic area/left ventricular end-diastolic area(RV/LV),inferior vena cava diameter,creatine kinase-MB and cardiac troponin-T(cTnT)),lung function(forced expiratory volume in one second(FEV1)and FEV1/forced vital capacity(FEV1/FVC)),blood gas indexes(arterial oxygen pressure/fraction of inspired oxygen(PaO2/FiO2),arterial oxygen saturation(SaO2),arterial oxygen pressure(PaO2)and arterial carbon dioxide pressure(PaCO2)),and complications were compared between the two groups.Results The FEV1,FEV1/FVC,PaO2/FiO2,SaO2 and PaO2 in the observation group were higher than those in the control group(P<0.001,P<0.01 or P<0.05).The PaCO2,creatine kinase-MB,cTnT,RV/LV,inferior vena cava diameter and incidence of complications in the observation group were lower than those in the control group(P<0.001,P<0.01 or P<0.05).Conclusion Oxygenation index-guided advanced pulmonary rehabilitation training combined with prone position ventilation can effectively and safely improve pulmonary function and blood gas indexes,relieve clinical symptoms,alleviate the damage of mechanical ventilation-caused cardiac impairment,and reduce the incidence of complications in elderly patients with severe ARDS.